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目的:探讨唇部及口腔鳞状细胞癌调强放疗失败的原因。方法:55例唇部及口腔鳞状细胞癌患者接受调强放疗,其中49例为术后放疗,5例为根治性放疗,1例为新辅助放疗。通过复发时CT图像与治疗计划用CT图像的融合或对比来判断复发方式。结果:9例患者出现局部区域复发:4例仅有局部复发,2例仅有区域复发,3例局部+区域复发。5例患者出现远处转移,其中3例合并局部区域复发。2年总生存率、疾病特异性生存率、局部无复发生存率、局部区域无复发生存率、以及远处无转移生存率分别为68%、74%、85%、82%和89%。从治疗结束到局部区域复发的中位时间为4.1个月。除1例失败出现在照射野外的对侧下颈部外,其余的失败都出现在接受高量放疗的部位。局部区域控制与淋巴结包膜外侵显著相关。结论:调强放疗是唇部及口腔鳞状细胞癌的有效治疗方式。绝大多数治疗失败的方式为“照射野内”复发,建议术后同步化放疗用于有淋巴结包膜外侵的唇癌及口腔癌患者。
Objective: To investigate the reasons for the failure of intensity modulated radiotherapy in lip and oral squamous cell carcinoma. METHODS: Fifty-five patients with lip and oral squamous cell carcinoma received IMRT, of which 49 were postoperative radiotherapy, 5 were radical radiotherapy, and 1 was neoadjuvant radiotherapy. The relapse pattern is judged by the fusion or contrast of the CT images of recurrence with the CT images of the treatment plan. Results: Local recurrence occurred in 9 cases: only 4 cases had local recurrence, 2 cases had only regional recurrence, and 3 cases had local + regional recurrence. 5 cases of distant metastasis, including 3 cases of local recurrence. 2-year overall survival, disease-specific survival, local recurrence-free survival, local recurrence-free survival, and distant metastasis-free survival were 68%, 74%, 85%, 82%, and 89%, respectively. The median time to relapse from the end of treatment to the local area was 4.1 months. Except for one case of failure in the contralateral side of the neck exposed to the field, the rest of the failure occurred in the place to receive high doses of radiation. Local regional control and lymph node envelope invasion was significantly correlated. Conclusion: IMRT is an effective treatment for oral and oral squamous cell carcinoma. The vast majority of treatment failure for the “radiation field ” recurrence, it is recommended that postoperative synchronized radiotherapy for lymph node capsule invasion and lip cancer and oral cancer patients.